The U.S. Department of Health and Human Services (HHS) today issued the final rule to revise the regulations governing the Title X family planning program, which focuses on serving low-income Americans.

The final rule ensures compliance with statutory program integrity provisions governing the program and, in particular, the statutory prohibition on funding programs where abortion is a method of family planning. The final rule amends the Title X regulation, which had not been substantially updated in nearly two decades, and makes notable improvements designed to increase the number of patients served and improve the quality of their care.

A proposed rule regarding the Title X program was published in the Federal Register on June 1, 2018, with a 60-day public comment period. The Department received and carefully reviewed more than 500,000 comments, and made certain changes to the final rule as a result of its consideration of the comments.

The Title X program annually serves approximately 4 million people, and the updated rule seeks to ensure a holistic and health-centered approach, safeguarding the short- and long-term family planning needs of more women, men, and adolescents in need of services. Key elements of the final rule include:

Requiring clear financial and physical separation between Title X funded projects and programs or facilities where abortion is a method of family planning. This separation will ensure adherence to statutory restrictions, and provide needed clarity for the public and for Title X clinics about permissible and impermissible activities for Title X projects.

Prohibiting referral for abortion as a method of family planning. The final rule does not bar nondirective counseling on abortion, but eliminates the requirement that Title X providers offer abortion counseling and referral. It protects Title X healthcare providers so that they are not required to choose between participating in the program and violating their own consciences by providing abortion counseling and referral.

Improving program transparency by requiring more complete reporting by grantees about subrecipients and more clarity about informal partnerships with referral agencies, to ensure provision of quality family planning services and compliance with statutory and regulatory requirements.

Protecting women and children who have experienced child abuse, child molestation, incest, sexual abuse, rape, intimate partner violence, and trafficking by:

Requiring that Title X clinics provide annual training for staff and have a site-specific protocol in place to protect victims/survivors of sexual assault.

Requiring compliance with State and local laws on reporting or notification of these crimes.

Requiring counseling for minors on how to resist attempts to coerce them into sexual activities.

Requiring clinics to encourage meaningful parent/child communication – and, as required by federal law, to encourage family participation, especially in a minor’s decision to seek family planning services – and to provide practical ways to begin (and maintain) such communications.

Maintaining the confidential relationship between patients and medical professionals within the statutory requirements.

Clarifying that individuals may be considered for Title X services if they are unable to obtain employer-sponsored insurance coverage for certain contraceptive services due to their employer’s religious beliefs or moral convictions and the limitations of their own financial resources.

Providing high quality comprehensive family planning services to those currently unserved or underserved, while ensuring the integrity of the Title X program, consistent with statutory requirements.

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